Series of Devices for Preparing the Displacement, in Particular a Permanent Displacement, of the Occlusal Plane of a Person, and Associated Methods

The present invention is in the field of dentistry. In dentistry, complexly designed devices and methods are used to:

Dentistry includes, for example:

Well-known series of devices are also known as aligners because they have an alignment function that aligns teeth. However, it may be dentally unfavorable if only the alignment functions are considered singularly.

It is therefore the task of the invention to provide a series that has functions that go beyond the functions used to date or that have other functions. In particular, it should be possible to change the position of a chewing plane, for example in a simple manner and/or in combination with alignment functions or displacement functions, which may affect the teeth of the entire dental arch or an arch-shaped tooth element structure. Furthermore, associated methods and associated units should be disclosed, such as a computer system, a computer program, a computer program product and associated digital design data and associated digital manufacturing data. An associated treatment plan should also be disclosed, in particular a digital treatment plan.

This task is solved with regard to the series by the series specified in patent claim. Further embodiments are indicated in the dependent claims. The tasks relating to the methods and the other units are solved by the patent subject matter of the corresponding independent claims. Here too, further embodiments are indicated in the dependent claims.

The series may comprise devices to assist in displacing a person's chewing plane. There may be at least two, five, ten, etc. devices or at least two, five, ten, etc. pairs of devices. The devices or pairs of devices may each comprise at least one jaw device. The at least one jaw device may each comprise or consist of an upper jaw device and/or a lower jaw device.

According to one embodiment, the devices or pairs of devices may be designed to be worn by the person according to a predetermined sequence, in particular according to a sequence defined in a treatment plan, in particular in a digital treatment plan stored or storable on a computer.

According to one embodiment, the jaw device may extend from a receiving region for a left molar (tooth) element via at least one receiving region for an anterior element or a canine element to a receiving region for a right molar element. Thus, the jaw device may comprise at least one first receiving region for a left molar (tooth) element, at least one second receiving region for an anterior tooth or canine tooth element and at least one third receiving region for a right molar (tooth) element. The receiving regions may be arranged in device elements of the device, e.g. in veneer elements or tooth veneers, e.g. at anterior tooth positions or canine tooth positions or in device elements or height elements in the molar region (molar, premolar).

According to one embodiment, the jaw device may define a plane.

According to one embodiment, in at least one device, the at least one jaw device may comprise at least one height element on a first side.

According to one embodiment, at least two contact areas may be formed on the at least one height element at different positions of molar (tooth) elements, in particular local contact areas, which may be parts of a larger contact area, e.g. a larger flat contact area. The two contact areas on the height element or the two local contact areas on the height element may have a distance between them of at least 10 mm or at least 15 mm, e.g. less than 30 mm. This may allow at least two points of a plane to be defined in a simple and/or defined manner. The contact areas may be in contact with tooth elements during biting if no device is placed on the opposite jaw or in contact with the device on the opposite jaw, in particular with tooth replicas or other areas of the opposite device.

For example, there may only be one height element on the first side, which has two contact areas, for example. Alternatively, there may be, for example, two or at least two height elements, each of which has at least one contact area, e.g. exactly one contact area or more than one contact area.

According to one embodiment, at least one further contact area may be formed on a second side of the at least one jaw device, in particular also a local contact area, which may be part of a larger contact area, for example a larger planar sliding area.

The contact areas, in particular the local contact areas, may be punctiform or typically planar, especially if compliant, plastically deformable or elastically deformable materials are used for the devices or pairs of devices.

According to one embodiment, the at least three contact areas may define the plane. If there are more than three contact areas, these may lie in one plane. Alternatively, a plane may be determined using suitable mathematical methods, e.g. using the least sum of squares method or a similar method in which another suitable mathematical measure is used for minimization when determining the position of the plane. Instead of the plane, reference may also initially be made to two straight lines, which then define the plane.

According to one embodiment, the plane may deviate from a starting chewing plane of the person or from a current chewing plane of the person with regard to its inclination changed by the at least one height element in a frontal section and/or sagittal section and/or with regard to its height position changed by the at least one height element. A frontal section may, for example, be perpendicular to a support plane on which the device rests. The frontal section may be made through the same tooth positions on the right/left, particularly in the molar region. The sagittal section may be parallel to a left/right center line of the device and may also be parallel to a support plane on which the device rests. When resting on the device, the receiving regions for tooth elements may face downwards, i.e. towards the support plane. This may apply to both the lower jaw device and the upper jaw device. Occlusal surfaces of the device may also be suitable for resting on a plane in order to define the frontal section and/or the sagittal section. In other variants, a frontal section/sagittal section may be defined on the basis of skull structures or digital images of skull structures of a patient, which is explained in more detail below.

According to one embodiment, in at least one other device of the series, a different inclination in a frontal section or sagittal section and/or a different height position (e.g. distance to a cranial structure) of the respective plane may be adjusted/set by at least one further height element, which differs from the at least one height element in the adjusted/set height.

According to one embodiment, in at least one device of the devices, the at least one jaw device may thus comprise at least one contact area on at least one height element. The at least one contact area may define a plane, in particular a plane that may deviate from a starting chewing plane of the person or from a current chewing plane of the person with respect to its inclination changed by the height element. The position of the person's chewing plane may be determined using mathematical methods.

The height element may adjust or set a distance of at least 1 mm (millimeters) of at least 2 mm or at least 3 mm between the contact area and an occlusal surface of an underlying tooth element or a surface facing away from the contact area in a receiving region for the underlying tooth element. In the case of a maxillary device, it may also be said that the tooth element lies below the contact area, as it is covered by the latter.

The at least one height element or the height elements may adjust or set a height that is at least twice as high or at least three times as high as a height of the at least one device above the at least one receiving region for the anterior tooth element or for the canine tooth element.

The plane may be a contact plane in which the at least one contact area of the height element and preferably other contact areas are located, e.g. contact areas on height elements or on other elements or surfaces of the device, e.g. a lower jaw device and/or an upper jaw device.

In the contact plane, there may be a keying, i.e. height profiles, which may prevent sliding movements. Nevertheless, a new chewing plane may be learned by the person, e.g. during the chewing movement when eating or during involuntary chewing movements outside of mealtimes. Habituation effects may also lead to relearning.

According to another embodiment, the at least one contact area may be a sliding contact area and may define a sliding plane in which the jaw device may slide such that the person is assisted in learning a new chewing plane that may differ from the person's current chewing plane, for example with respect to its inclination or another parameter. For example, the upper jaw device and the lower jaw device may slide relative to each other in the plane defined by the at least one contact area. Instead of sliding movements, rolling movements or rolling-sliding movements may also be possible. Flat sliding surfaces may therefore be used at the contact areas or differently shaped sliding surfaces.

“Sliding” here may mean that transverse relative movements between the jaw device and an opposing dental arch or between two jaw devices of a device are possible by at least one value that is in the range of 1 mm (millimeters) to 5 mm or in the range of 1 mm to 3 mm. The minimum value may therefore be 1 mm, 2 mm or 3 mm, for example. The maximum value of the relative movement may be given by the anatomy of the jaws or by additional ramps that may form a stop.

Sliding may be possible in at least one spatial direction or in at least two spatial directions that are orthogonal to each other. In the case of two spatial directions, the values specified above for the sliding movement may apply to one of the two spatial directions, e.g. left-right or rear-front, or to both spatial directions.

The deviation of an angle of inclination in the frontal plane or in the sagittal plane may, for example, be in the range of 0.2 degrees to 2 degrees or in the range of 0.5 degrees to 1 degree. The angle may be measured between the two chewing planes that are compared, e.g. if they are superimposed using the same reference point. The angle may then be determined between the directions of the surface normals.

In a further embodiment, the angle may be determined relative to a reference structure, e.g. a sagittal plane of the person's head, etc.

The deviation in the inclination may be manifested by a “tilting” of the chewing/masticatory plane, whereby a change in the distance from the occlusal reference point of a tooth to the chewing/masticatory plane may occur at at least one tooth position according to a tooth scheme or at several tooth positions. The distance may change, for example, in the range of 0.5 mm to 2 mm. No change in the distance may occur at other tooth positions. At other tooth positions, the distance may change in the opposite direction.

In addition or alternatively, there may also be a transverse displacement of the chewing/masticatory plane in the current chewing/masticatory plane or in the chewing/masticatory plane whose inclination has changed, e.g. from back to front, from front to back, from left to right or from right to left, rotation around the surface normal of the chewing/masticatory plane, etc. A parallel shift of the chewing/masticatory plane may also take place in addition to or as an alternative to the change in inclination, whereby a transverse displacement may be carried out or whereby no transverse displacement may be carried out.

The plane, e.g. the sliding plane, may be defined by contact areas, e.g. by one contact area, by at least two contact areas, by at least three contact areas, by at least four contact areas or by more than four contact areas. In this way, the position of a plane may be defined by at least three points. The size and/or number of contact areas may make it easier to define the sliding plane or its stable position in space.

The contact area may be flat, e.g. to better define the position of the sliding plane. The lateral extent of the flat surface of the contact area may exceed the extent of areas that are usually formed by a fissure on teeth/tooth elements. This may make it possible to avoid a so-called “keying” of teeth or tooth elements of the upper and lower jaw, i.e. a lateral relative movement of the upper and lower jaw may be made possible. This lateral mobility may enable the chewing/masticatory muscles and/or the person's brain to be stimulated to make lateral corrections to the position of the upper jaw or lower jaw and thereby learn the new position of the chewing plane, in particular the new inclination. An edge gap between the jaw device and teeth or dental elements may support the relearning process, but is not a prerequisite.

A contact area of an upper jaw device may be opposite a contact area in a lower jaw device. If the contact area is flat, “keying”, which may manifest itself in “latch/lock biting”, may be effectively prevented if there is a flat sliding surface only in the upper jaw device at the sliding contact area or only in the lower jaw device at the sliding contact area. Opposite the flat sliding surface, there may be at least one sliding element that may slide on the plane, e.g. only one sliding element, two sliding elements, three sliding elements or more than three sliding elements. The at least one sliding element may, for example, be a protrusion that is the size of a dental fissure, e.g. a dental fissure itself or a replica of a dental fissure. Alternatively, the protrusion may also be smaller than a dental fissure, i.e. a maximum lateral dimension may, for example, be smaller than 2 mm or even smaller than 1 mm. Rounded protrusions may reduce friction. A contact line may be formed, e.g. when a cylinder or wedge makes contact with a sliding plane. The cylinder or wedge may extend along a transverse direction, e.g. from a left molar to a right molar.

The at least one sliding element may have a preferably point contact with the flat sliding surface of the contact area or a linear contact, which may reduce the mechanical friction between the two. On the other hand, a greater hardness of the material of the flat sliding surface or a sliding element may be used in the case of an approximately point contact or a linear contact. If there is a small planar contact, softer materials may be used to form the sliding surface and/or the contact element.

In general, the position of a masticatory plane may be defined by three angles of the surface normal of the masticatory plane or a tangent to the masticatory plane to three coordinate axes of a Cartesian coordinate system and by three position coordinates with respect to the three coordinate axes, i.e. by a total of six parameters.

The inclination of the chewing/masticatory plane may therefore be described by, for example, two (room) angles between the normal of the/masticatory plane and two of the coordinate axes or three of the coordinate axes, whereby the normal may be extended in the direction of the origin of the coordinates and/or shifted parallel so that it intersects the relevant coordinate axis, for example. The plane in which the angle is then determined may be the plane that comprises both the surface normal and the coordinate axis. In this context, we may also talk about tilt angles or inclination.

A third angle may describe a rotation/twisting of the chewing plane, e.g. a twisting of a front-back “center line” of the dental arches, whereby the center line may lead exactly through a point of contact of the front incisors or in the middle of a gap that may lie between these incisors. The two incisors may preferably each lie in a different quadrant of a tooth pattern. At least one coordinate axis may be projected into the chewing/masticatory plane in order to determine the third angle in the chewing/masticatory plane, i.e. the angle between the projection of the coordinate axis and the centerline. On the other hand, the center line may also be projected into a plane in which two of the three coordinate axes lie in order to determine the third angle there. In this context, it is also possible to speak of a rotation of the chewing/masticatory plane within the chewing/masticatory plane.

A reference point on a tooth or tooth element may be used to determine the position of the chewing plane, e.g. the incisal point (contact with or gap center between the two front incisors in the lower jaw), a corresponding point may be used in the upper jaw. Alternatively, another reference point on a tooth or tooth element may be used to determine the position of the chewing plane. Alternatively, the reference point may also be determined in another way, e.g. on a geometric shape that circumscribes the respective dental arch, e.g. a triangle, a quadrilateral, a pentagon, etc. Other options for defining a suitable reference point may also be used.

In particular, the series of devices may be assigned to the same person and/or aimed at a uniform treatment goal for this person's teeth.

The use of the proposed series may therefore make a decisive difference to known series, because in known methods the chewing plane is not displaced at all or only after a displacement of the teeth/tooth elements or a widening or other change of a dental arch carried out with the series. This may lead to blockages when teeth/tooth elements are displaced and/or to the person counteracting the displacement as soon as the devices are no longer used. For example, teeth that have been built up in a final restoration may be “chewed off” again because the person has not yet learned where the new chewing plane should be. This may be counteracted with the proposed series, because the new position of the chewing plane may be adjusted (set) and/or learned first and, if necessary, tooth positions/arches may be shifted or the final restoration may be made only afterwards.

In particular, relearning may be neuromuscular relearning. Relearning may be achieved through habituation and/or conscious training.

There may be at least 10, at least 20 or at least 30 devices in the series. There may be less than 100 devices in the series. The exact number of devices may be specified in a treatment plan and may depend, for example, on whether or not attachments are used or what pressure on their teeth the person concerned still finds acceptable.

The attachment of attachments to the teeth may play an important role in the success of the treatment. Compared to the teeth, the attachments may be small fastening elements made of composite, i.e. a tooth-like substance, which ensure that tooth movement may take place more quickly, easily and efficiently. The attachments may act as an anchor that the aligner grips to accomplish the movement. Attachments allow the necessary pressure for tooth movement to be applied precisely. In addition, the attachments may enable complex movements such as the rotation of the teeth and ensure that the correction takes place without unnecessary “intermediate movements”. Attachments may be used, for example, to move teeth away from the jaw.

In principle, treatment may also be carried out without attachments. For some malalignments, attachments are simply not required and/or may be omitted or scheduled for a later date if desired. Treatment without attachments may result in more splints being required to achieve the target alignment.

The devices may remain in the mouth while eating, so that the person/patient may get used to the new position of the chewing plane even while eating. Teeth or remaining dental element structures of the person may form at least one new bite structure together with the devices, the bite plane of which may correspond to the new position of the chewing plane, e.g. an intermediate chewing plane, a training chewing plane or the planned final chewing plane. After eating or at the usual times, the respective worn device may be removed from the mouth in order to simply clean the teeth and/or the device, e.g. the respective upper jaw device and/or the respective lower jaw device.

In another embodiment, the device or devices may also be removed from the mouth when eating. The new position of the chewing plane may then be learned in the periods between meals.

The tooth element structure may be formed from several tooth elements. A tooth element may be a natural tooth, e.g. a non-treated tooth, a treated tooth (e.g. comprising one or more fillings), a partially crowned tooth, a fully crowned tooth or an artificial tooth, in particular a tooth with an artificial tooth root, an implant, a veneered tooth, a pin tooth, a ground or grinded tooth, an implant fastening device, in particular a pin-shaped fastening device, etc.

Between the first device and the second device, in all of the above embodiments, no further devices of the series may be interposed according to the predetermined sequence. On the other hand, a further device or further devices of the series may be interposed between the first device and the second device in all of the above embodiments in accordance with the predetermined sequence. The first device may have the number 1 in the numbering of the devices, but does not have to. The second device may or may not have the number 2 in the numbering of the devices. However, the second device is in the sequence after the first device. The first device may therefore have a number n, where n may be a natural number greater than 1. The second device may then have a number n+1 or a number n+m, where m is also a natural number, in particular greater than zero and, for example, also greater than 1.

In particular, this may involve the preparation of a permanent displacement of the chewing/masticatory plane, which may differ, for example, from a temporary displacement, e.g. to enable certain tooth displacements. In particular, the permanent chewing/masticatory plane may be permanently set in a final restoration, e.g. by using table tops (height build-up) and/or onlay(s) (with grinding of the tooth surface), crown(s), bridges, implants, in particular also combinations of the aforementioned elements. Blocking over several teeth should be avoided as far as possible in order to prevent disadvantages such as damage to the fine retaining fibers (Sharpey fibers) of the teeth.

In this way, the position of the chewing/masticatory plane may be built up to the last aligner, directly, e.g. by asymptotic approximation, or indirectly, i.e. with overshooting, which is explained in more detail below.

The final height position of the chewing/masticatory plane or the final position of the chewing/masticatory plane may be a physiologically suitable position of the chewing/masticatory plane. This final position may differ from a non-permanent position of the chewing/masticatory plane, such as may be used, for example, for “shunting activity” to relocate individual teeth or for only temporary, in particular exaggerated, neurological reprogramming. The final position or the target position of the chewing/masticatory plane may adjust or set a new axial position in relation to the joint axis of the chewing/masticatory joint.